Evidence-Based Practice: Course Examples

1. Evidence-Based Practice:Course Examples Curry College Division of Nursing NSG 2200 Pathophysiolgy or your course Spring 2007 Elizabeth Kudzma

2. Evidence-Based Practice (EBP) • Process by which health care providers know how to find, critically appraise, and use the best evidence

3. Why Evidence-Based Practice (EBP) ?? Health care delivery is filled with uncertainty and many questions arise in every day practice… • What kind of guidance would be most helpful to my patients? • What clinical assessments and interventions are of the most benefit?

4. Common questions that arise in everyday practice: • Which combination and sequence of treatments is most effective? • Which patient symptoms predict better or worse outcomes? • What is the experience of illness for a patient with this diagnosis? • Which treatment is most effective and will produce the best patient outcome? • If a diagnosis is left untreated, what might be the outcome?

5. Evidence to Support Best Practices is Constantly Changing

6. Formulating the Clinical Question • The “PICO” format is used to construct the clinical question specifically • Using PICO format helps you find a needle in a hay stack of research information

7. PICO Format • Patient Population • Intervention of Interest • Comparison intervention or status • Outcome

8. Patient Population • Consideration of the patient and population of interest • Limit to age group or subgroup if possible

9. Intervention • Exposure • Treatment • Patient perception • Diagnostic test

10. Comparison • Could be true control, such as placebo or doing nothing • Could be another treatment • Sometimes it is the usual standard of care

11. Outcome • Outcome may be very specific, e.g. death • Outcome may be something that has a variety of measures, e.g. dehydration could be a measure, also tachycardia, dry mouth, fever, restlessness and irritability

12. PICO format example • Are 35 to 55 year-old women (p) who have high blood pressure (I) at increased risk for acute myocardial infarction (O) compared with women without hypertension (C)

13. Rating System for Evidence • Level I: evidence from systematic review, randomized controltrials (RCTs), or evidence-based reviews • Level II: evidence from one well-designed RCT • Level III: evidence from well-designed studies without randomization • Level IV: evidence from other types of studies including case-control and cohort studies • Level V: evidence from systematic reviews of descriptive and qualitative studies • Level VI: evidence from one descriptive or qualitative study • Level VII: evidence from the opinion of authorities and/ or reports of expert committees • Meynyk, B. & Fine-Overholt, E.. (2005). Evidence-Based Practice in Nursing and Healthcare. Lippincott, Wiliams & Wilkins.

14. A Rating System for Looking at Evidence in Individual Studies • Level A: Randomized control trial (RCT) • Level B: (other evidence) • Well-designed, nonrandomized trial • Non-quantitative systematic review • Lower quality RCT’s, clinical cohort studies, case-control studies • High-quality historical, less controlled studies, well-designed epidemiological studies • Level C: consensus/expert opinion Siwek, J. et al. (2002). Am Fam Physician 65, 251-258.

15. Searching for the Best Evidence: Searchable Databases • CINAHL • MEDLINE: (PubMed) • National Guidelines Clearinghouse: http://www.guideline.gov • Agency for Healthcare Research and Quality: www.ahrq.gov/clinic/cpgsix.htm • National Institute of Nursing: http://ninr.nih.gov/ninr